Prior Procedures Research Articles

A justiça mnemônica como mínimo ético do procedimento dialógico perante a Câmara de Reconhecimento da Verdade, Responsabilidade e Apuração de Fatos e Conduta da Jurisdição Especial para a Paz, para garantir os direitos das vítimas no âmbito do Caso 01

The Special Jurisdiction for Peace (SJP) integrates a prior dialogic procedure in its institutional arrangement. This procedure aims to facilitate interactions between participants and victims to enhance contributions to the truth. This procedure faces problems that hinder the guarantee of victims' rights, conflicting with the principle of centrality of the victims. In this framework, we propose a mnemonic justice model as an ethical and procedural minimum at this stage of the process. This model can offer the participants tools to address to the needs of the victims in an effective manner.

Efficacy and Complications of Percutaneous Balloon Compression for Patients With Trigeminal Neuralgia With and Without Concomitant Continuous Pain

BACKGROUND: Percutaneous balloon compression (PBC) has become one of the most common and effective minimally invasive treatments for trigeminal neuralgia (TN). However, the initial and long-term pain outcomes, as well as the complication rates of PBC for patients with TN with concomitant continuous pain (CCP) have yet to be specifically documented. OBJECTIVE: In this clinical study, we aimed to evaluate and compare the results of PBC in treating TN with and without CCP. STUDY DESIGN: Retrospective study. METHODS: This research retrospectively analyzed the pain outcomes and complications of 57 patients with TN with CCP and 118 patients with TN without CCP who had undergone PBC at our institution from January 2019 through June 2022. Procedures were performed by one senior neurosurgeon in a single center. The postdischarge follow-up and the collection of clinical data, including immediate and long-term pain relief, time to recurrence, and complications, were completed through phone contact by an independent neurosurgeon blind to the patients’ information. Then, the results of the 2 groups were compared; demographic and clinical data were evaluated for possible predictive factors for poor pain outcomes. RESULTS: In this study, PBC immediately resulted in complete pain relief in 70.2% of patients with CCP and significant pain relief in 84.2% of patients with CCP. For patients without CCP, the rates were 73.7% for complete pain relief and 85.6% for significant pain relief. After a minimum 6-month follow-up period, the rates decreased to 52.6% for complete pain relief and 73.7% for significant pain relief in patients with CCP, compared to 54.2% and 75.4% in those without CCP. The initial and long-term pain control rates in patients without CCP were slightly higher than those with CCP, but the differences were not statistically significant (P = 0.878, P = 0.968, respectively). The incidences of postoperative complications were similar between patients with and without CCP (21.1% vs 22.0%, P = 0.883), whereas the remission rate of complications in patients with CCP was significantly lower than that in patients without CCP (25.0% vs 69.2%, P = 0.011). A longer symptoms duration and having a history of neurodestructive procedures were predictive factors for poor outcomes following PBC. LIMITATIONS: The study was performed in a single-center. The nature of this research is retrospective instead of prospective and randomized, with the inability to control completely for variables. Additionally, the follow-up duration was not long enough to observe recurrence in some patients. CONCLUSIONS: This is the first specifically reported experience treating TN with CCP with PBC. PBC can result in significant relief of both episodic and constant pain from TN with CCP. Patients with a longer duration of pain and prior neurodestructive procedures have a higher risk of poor outcomes. The presence of CCP is not associated with pain outcomes and should not be considered a contraindication to PBC. KEY WORDS: Percutaneous balloon compression, trigeminal neuralgia, concomitant continuous pain, pain relief, comparison, efficacy, complication, predictive factor

Utility of Follicular Unit Excision Using Nonscalp Donor Hair.

Nonscalp donor hair harvesting or body hair transplantation offers patients an additional source of donor hair in cases when the scalp does not have an adequate supply for the intended recipient area. The most common applications for nonscalp donor hair are for patients with advanced hair loss or to camouflage scarring from prior hair restoration procedures. For patients with available body hair, the beard is probably the best source followed by the chest and abdomen. Combined, these sources may be able to provide thousands of additional grafts for transplantation. Nonscalp hair donor harvesting is technically challenging and should be performed by those with extensive experience in follicular unit excision surgical techniques.

Atypical flutter: effectiveness of a systematic strategy based on comprehensive high-density map analysis

Abstract Introduction High-density mapping tools expanded the mechanism characterization of atypical flutters (AFl). Systematic analysis of substrate and activation maps is critical for proper interpretation and targeted ablation strategy. Purpose Between 2016 and 2017, we developed a comprehensive stepwise workflow for AFl map interpretation in 25 pts. This study evaluates its effectiveness in a validation cohort. Methods Prospective single-center study of pts with left-sided AFl referred for ablation from 2018 to 2022. Pts with prior AFl ablation procedures were excluded. Complete high-density map collection was performed using Carto, Ensite or Rhythmia, displaying only voltage data. The comprehensive workflow was applied for activation map interpretation, starting by facing the mitral annulus and following the sequence of colors to systematically identify all potential circuits, their common-isthmuses and eventual slow-conduction sites. Additional algorithms (Coherent, Ripple, SparkleMap or LumiPoint) were used subsequently for interpretation validation purposes. A mechanism-tailored ablation strategy was applied targeting AFl common-isthmuses. If AFl persisted after completion of 1st ablation set, a remap was performed. Acute success was defined as conversion to sinus rhythm with the completion of the final ablation set. Entrainment maneuvers were only used to confirm the interpretation if AFl persisted after completion of the planned ablation set. Arrhythmic relapse was defined as atrial fibrillation or AFl recurrence. Results 72 pts were included in the AFl validation cohort (male 61.1%; 67±12 years old). Substrate maps revealed low-voltage areas (<0.3 mV) out of the pulmonary veins in 88%. AFl mechanism was macro-reentrant in more than 88%, most often with dual-loop circuits (50%, N=36) and including a perimitral rotation (54%, N=36 pts). The 1st set of mechanism-tailored ablation restored sinus rhythm in 49 pts (68%). The residual AFl (N=23) was found to be: (1) same AFl using a line gap (N=5); (2) same AFl using a loop previously not recognized in 1; (3) completely different AFl with a distinctive circuit (N=12); or (4) a right-sided peri-tricuspid flutter in 5 pts. Completion of the ablation set resulted in sinus rhythm restoration in 21 of these 23 pts, resulting in an overall acute success rate of 97% (70/72). In the remaining 2 pts, response to entrainment maneuvers was compatible with conduction persistence through the ablation line, being unsuccess explained by ablation failure. After a single procedure, the 3y success rate was 63% increasing to 74% with additional procedures - pic2. Conclusion This comprehensive stepwise workflow for AFl high-density map allows a mechanism-tailored ablation strategy that results in a very high acute and long-term success rate. Our study enforces that if AFl persists after the 1st ablation set and a remap is pursued, the additional targeted ablation usually results in a final procedural success.

Abstract 17087: Novel Machine Learning Models to Enhance and Automate Cardiovascular Outpatient Triage for Patients With Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is the most prevalent arrhythmia, placing a substantial burden on the healthcare system. Patients with AF are cared for in a variety of settings including primary care and cardiology clinics, while some require cardiac electrophysiology (EP) clinics offering specialized drugs or procedures. Appropriate triage of AF referrals to these specific clinics will lead to timely and appropriate care and reduce inefficiency in the health system. Goal: To develop a machine learning (ML) model to triage AF referrals to a large Cardiology center to either the Cardiology or EP clinic based on likelihood of requiring an invasive EP procedure or initiation of antiarrhythmic drug. Methods: We retrospectively analyzed 6,755 patients who were referred to CV with referral diagnosis of AF (mean age 70 ± 11 years, 66% male). We employed multiple input variables to predict the suitability for EP clinic defined as need for initiating an antiarrhythmic drug or an invasive EP procedure. These encompassed patient demographics, relevant comorbidities, medications, prior procedures, medical notes analyzed using natural language processing (NLP), and Holter monitoring data. Results: For internal referrals, XG boost model performed the best with AUC at 79%, accuracy at 72%, and F1 score at 68%. This model produces true positive (TP) at 68% and true negative (TN) at 74%, which was better in comparison with triaging using NLP only (AUC = 69%, TP = 58%, TN = 61%), Holter only (AUC = 52%, TP = 51%, TN = 77%), and NLP/Holter (AUC = 67%, TP = 60%, TN = 60%). When supplementing ML model with Holter readings on average HR ≥ 100 and maximum HR ≥ 150, the results can be improved to TP at 70% and TN at 73%. Conclusions: Our model effectively identifies patients who are more likely to require specialized EP care, enabling the automation and increased efficiency of the AF referral triage process. Prospective validation studies are paramount in determining the true value of this tool.

Abstract 13261: Global T Wave Inversion: Incidence and Implications in Critically Ill Patients

Background: Symmetric global T-wave inversion (GTWI) occurs in 0.3% of general hospital admits. As reported by Walder and Spodick, GTWI exhibited a 4:1 female preponderance and was often associated with ACS or central nervous system (CNS) disorders; in-hospital mortality was not affected. Anecdotally we have observed this ECG pattern in critically-ill medical ICU (MICU) patients. We hypothesized that GTWI is more prevalent among MICU patients and may be associated with adverse outcomes. Methods: We reviewed the ECGs, demographic, clinical, and physiological data of 1652 consecutive patients admitted to 2 medical ICUs. Those admitted to CCU and Neuro ICU were excluded as were MICU patients with a primary diagnosis of ACS, acute CNS syndrome, LBBB, ventricular pacing, pre-excitation, and uninterpretable ECG. ECGs performed within 48 hours of ICU admit were reviewed by 2 blinded readers. GTWI was defined by the criteria of Walder and Spodick. The GTWI group was compared to 95 matched patients without GTWI. Results: See Table. GTWI occurred in 75 patients (4.5%); 56% of whom were female. Significant differences between GTWI vs control included history of CAD (p=0.03), cardiomyopathy (p=0.035), CKD (p=0.046), and prior EP procedure (p=0.023). In addition, QT-interval (p<0.0001), QTc (p<0.0001) and BNP (1433±1725 vs 750±978 pg/mL; p=0.032) were greater in the GTWI group. LVEF (52.7±16.2% vs 55.6±14.1%) and cTnI (1.35±2.52 vs 1.25±4.15 pg/mL) were similar. MICU days and APACHE II score were greater in those with GTWI. Total length of stay and in-hospital mortality were similar. Conclusions: In this critically-ill MICU cohort, GTWI was more prevalent compared to previously reported general hospital admits. A distinct female preponderance was not found. This ECG pattern was associated with underlying cardiac disease, greater length of MICU stay and higher illness severity, but was not associated with higher in-hospital morality.

Long-term outcomes after responsive neurostimulation for treatment of refractory epilepsy: a single-center experience of 100 cases.

Despite antiepileptic drugs, more than 30% of people with epilepsy continue to have seizures. Patients with such drug-resistant epilepsy (DRE) may undergo invasive treatment such as resection, laser ablation of the epileptogenic focus, or vagus nerve stimulation, but many are not candidates for epilepsy surgery or fail to respond to such interventions. Responsive neurostimulation (RNS) provides a neuromodulatory option. In this study, the authors present a single-center experience with the use of RNS over the last 5 years to provide long-term control of seizures in patients with DRE with at least 1 year of follow-up. The authors performed a retrospective analysis of a prospectively collected single-center database of consecutive DRE patients who underwent RNS system implantation from September 2015 to December 2020. Patients were followed-up postoperatively to evaluate seizure freedom and complications. One hundred patients underwent RNS placement. Seven patients developed infections: 2 responded to intravenous antibiotic therapy, 3 required partial removal and salvaging of the system, and 2 required complete removal of the RNS device. No postoperative tract hemorrhages, strokes, device migrations, or malfunctions were documented in this cohort. The average follow-up period was 26.3 months (range 1-5.2 years). In terms of seizure reduction, 8 patients had 0%-24% improvement, 14 had 25%-49% improvement, 29 experienced 50%-74% improvement, 30 had 75%-99% improvement, and 19 achieved seizure freedom. RNS showed significantly better outcomes over time: patients with more than 3 years of RNS therapy had 1.8 higher odds of achieving 75% or more seizure reduction (95% CI 1.07-3.09, p = 0.02). Also, patients who had undergone resective or ablative surgery prior to RNS implantation had 8.25 higher odds of experiencing 50% or more seizure reduction (95% CI 1.05-65.1, p = 0.04). Responsive neurostimulator implantation achieved 50% or more seizure reduction in approximately 80% of patients. Even in patients who did not achieve seizure freedom, significant improvement in seizure duration, severity, or postictal state was reported in more than 68% of cases. Infection (7%) was the most common complication. Patients with prior resective or ablative procedures and those who had been treated with RNS for more than 3 years achieved better outcomes.

Exploring English Teachers’ Pedagogical Wellbeing and Classroom Issues: A Narrative Inquiry

This paper deals with the classroom issues of English as a Foreign Language (EFL) teaching in the context of Nepal and the EFL teachers' ways of addressing them. More specifically, it connects how pedagogical strengths help teachers address the issues that appear in language classrooms. The research has been carried out outlining the qualitative approach grounded in an interpretive research paradigm. The data were collected from three university teachers. Methodologically, the study adopts the three-dimensional narrative spaces as the prior procedures of research methods for theoretical insight. It concludes that teachers' profound knowledge and skills about their well-being are useful to integrate various cultures and content in the classrooms. Pedagogically inbuilt potentials of teachers maximally enhance learners' learning opportunities. Thus, the conclusion obtained in this study is assessed considering teachers' understanding, of classroom issues and their ways of addressing those problems but they may not be generalizable. However, it contributes to teachers' education in general and ELT practice in Nepal in particular.

A model for partially dependent component damage fragilities in seismic risk analysis

This article proposes a model to quantify dependencies in component damage in the Federal Emergency Management Agency (FEMA) P-58 seismic performance assessment methodology and to simulate damage realizations with the desired dependencies. The model is compatible with the prior FEMA P-58 procedure and can quantify more realistic dependencies in component damage with only minor changes to the calculation algorithm and model parameters. This article introduces the proposed model and compares it with the prior procedure. Example calculations are then used to illustrate the quantitative impacts of component damage dependencies on building-level performance metrics. The model is relatively simple to conceptualize and parameterize, so that the degree of dependency can be easily estimated and documented. Given the improved conceptual framing of the problem, and the significant changes it sometimes produces in building-level performance predictions, this model represents an improvement to the general FEMA P-58 seismic performance assessment methodology.

Decreasing false-positive detection of intracranial hemorrhage (ICH) using RAPID ICH 3

IntroductionThe prompt detection of intracranial hemorrhage (ICH) on a non-contrast head CT (NCCT) is critical for the appropriate triage of patients, particularly in high volume/high acuity settings. Several automated ICH detection tools have been introduced; however, at present, most suffer from suboptimal specificity leading to false-positive notifications. MethodsNCCT scans from 4 large databases were evaluated for the presence of an ICH (IPH, IVH, SAH or SDH) of >0.4 ml using fully-automated RAPID ICH 3.0 as compared to consensus detection from at least two neuroradiology experts. Scans were excluded for (1) severe CT artifacts, (2) prior neurosurgical procedures, or (3) recent intravenous contrast. ICH detection accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios by were determined. ResultsA total of 881 studies were included. The automated software correctly identified 453/463 ICH-positive cases and 416/418 ICH-negative cases, resulting in a sensitivity of 97.84% and specificity 99.52%, positive predictive value 99.56%, and negative predictive value 97.65% for ICH detection. The positive and negative likelihood ratios for ICH detection were similarly favorable at 204.49 and 0.02 respectively. Mean processing time was <40 seconds. ConclusionsIn this large data set of nearly 900 patients, the automated software demonstrated high sensitivity and specificity for ICH detection, with rare false-positives.

Transradial or Transulnar Long Sheath Access to the Brachial Artery Allows for Neuroendovascular Procedures in Patients with Radial or Ulnar Artery Occlusion

Transradial access is an important tool for many neuroendovascular procedures. Occlusion of the radial or ulnar artery is not uncommon after transradial or transulnar access and can present a challenge for patients requiring repeat angiography. Between March 2022 and June 2023, patients undergoing transradial or transulnar angiography who were found to have a radial artery occlusion or ulnar artery occlusion were identified. Repeat catheterization of the occluded artery was attempted using a 21-gauge single wall puncture needle and a 0.021-inch wire to traverse the occlusion and insert a 23-cm sheath into the brachial artery. A total of 25 patients undergoing 26 angiograms during the study period were found to have a radial artery occlusion or ulnar artery occlusion. Successful repeat catheterization of the occluded artery was achieved in 21 of 26 cases (80.7%). Outer diameter sheath size ranged from 5 Fr (0.0655 inch) to 8 Fr (0.1048 inch). No access complications were encountered. Number of prior angiograms, time since prior angiogram, and prior angiogram procedure time were associated with lower likelihood of successful access. Transradial or transulnar neuroangiography through an occluded radial or ulnar artery is safe and feasible by traversing the occlusion into the brachial artery with a 23-cm sheath. Repeat catheterization is most successful in patients with an arterial occlusion <6 months old. This technique is important in patients who have limited options for arterial access, avoiding access site complications inherent in transfemoral access, and in patients who specifically require radial or ulnar artery access.

Ethical human participant research in Central Asia: a quantitative analysis of attitudes and practices among social science researchers based in the region

Central Asian researchers are underrepresented in the global research production in social sciences, resulting in a limited Central Asian perspective on many social issues. To stimulate the production of local knowledge, it is important to develop strong research cultures, including knowledge of ethical practices in research with human participants. There is currently scarce evidence about research ethics regulations used by social science researchers working in the Central Asian region. This article reports findings from an online survey conducted in Kazakhstan, Kyrgyzstan, and Uzbekistan ( n = 296) from October 2021 to January 2022. Focusing on three Central Asian countries, this article addresses the following research questions: What are the attitudes and practices of social science researchers based in Central Asia toward research ethics regulations and research ethics committees (RECs)? Is research ethics training associated with improved attitudes and practices in relation to research ethics among social scientists based in Central Asia? Is research experience associated with improved attitudes and practices in relation to research ethics among social scientists based in Central Asia? Regression analyses results demonstrate that locally based social scientists with prior research ethics training implement ethical procedures in their empirical research practice more often compared to researchers without any prior research ethics training. The preliminary findings indicate that research ethics training is positively associated with Central Asia-based social science researchers’ engagement in ethical research, thus potentially increasing the amount and quality of empirical social science research produced in the region.

Isolated cervical Cutibacterium acnes osteomyelitis in a patient with no primary source of infection – A case report and review of the literature

Background: Cervical vertebral osteomyelitis (CVO) is a rare pathology that leads to progressive osseous degradation and eventual loss of bone putting the patient at risk of devastating neurological injury in the event of bony collapse or instability. Cutibacterium acnes formerly called Propionibacterium acnes is rare, but within the last two decades has been an increasingly reported cause of osteomyelitis. The majority of C. acnes vertebral osteomyelitis cases have been reported in patients with a history of prior invasive procedures where direct contamination at the time of procedure was suspected as the underlying etiology. Case Description: We report a unique case of an otherwise healthy 39-year-old male with no prior history of invasive procedures who presented with CVO secondary to C. acnes. He underwent surgical debridement and fusion in conjunction with antibiotic treatment. The patient recovered well and a 2-year follow-up with serial imaging showed no evidence of disease recurrence. Conclusion: C. acnes is an under-recognized and under-reported etiology of spine infections. Clinicians should be aware of the pathological potential and atypical presentation of C. acnes vertebral osteomyelitis.

Utility of Follicular Unit Excision using Non-Scalp Donor Hair.

Non-scalp donor hair harvesting, or body hair transplantation (BHT) offers patients an additional source of donor hair in cases when the scalp does not have an adequate supply for the intended recipient area. The most common applications for non-scalp donor hair are for patients with advanced hair loss, or to camouflage scarring from prior hair restoration procedures. For patients with available body hair, the beard is probably the best source followed by the chest and abdomen. Combined, these sources may be able to provide thousands of additional grafts for transplantation. Non-scalp hair donor harvesting is technically challenging and should be performed by those with extensive experience in follicular unit excision (FUE) surgical techniques.

FRI078 Real-World Weight Loss Outcomes And Safety Of Tirzepatide, A Novel Dual GIP And GLP-1 Receptor Agonist

Abstract Disclosure: S. Fansa: None. W. Ghusn: None. B. Nicolalde: None. D. Anazco: None. E. Tama: None. A. Acosta: None. M.D. Hurtado: None. Introduction: The increasing prevalences of obesity and type 2 diabetes (T2D), the “twin epidemics”, have led to the development of drugs targeting both diseases simultaneously. Liraglutide and semaglutide, GLP-1 receptor agonists used for T2DM, are also FDA-approved for weight loss. Tirzepatide, a novel dual GIP/GLP-1 receptor agonist approved for T2D, has shown promising weight loss outcomes in clinical trials. To date, no study has assessed weight loss outcomes of tirzepatide in a real-world setting. Our aim is to assess its efficacy and safety in patients with overweight or obesity. Methods: This is a retrospective cohort study of adults with overweight or obesity taking weekly subcutaneous tirzepatide for T2D or off-label for weight loss. We excluded patients taking tirzepatide for less than one month, prior bariatric procedure, use of any anti-obesity medications, and active malignancy or pregnancy. The primary outcome was total body weight loss percentage (TBWL%) at 3 months. Secondary outcomes included TBWL% at 1 and 2 months; TBWL% difference by T2D status (with and without) and by sex at 3 months; proportion of patients achieving ≥5%, ≥10%, and ≥15% of TBWL% at 3 months; predictors of TBWL% at 3 months; and reported side effects during follow up. We used paired t-test to assess TBWL% compared to baseline, non-paired t-test to compare TBWL% by T2D status and sex, and univariate analyses to estimate the contribution of other variables to TBWL%. Results are presented as mean ± standard deviation. Results: We included 175 participants (81% female, age 49.8±12.2, 91% white, BMI 38.8±7.3 kg/m2). One third of patients had T2D (n=59, 34%). Most patients were on 5mg (39%) or 7.5mg (22%) of tirzepatide weekly. TBWL% at 1, 2, and 3 months was 3.6±2.5% (n=87), 5.8±3.5% (n=100), and 8.4± 4.3% (n=60), respectively (p &amp;lt;0.0001 compared to baseline at all timepoints). Patients with T2D lost less weight at 3 months compared to patients without T2D: 6.9±4.0% vs. 9.1±4.4% (p= 0.03). At 3 months, TBWL% was greater in females, 9.2±4.3% vs. 5.0±2.5% for males, p&amp;lt;0.0001. Greater baseline weight was associated with greater TBWL% (R=0.32, p&amp;lt;0.0001). At 3 months, 60 patients had documented weights with 81.6% achieving ≥ 5%, 30% achieving ≥10%, and 10% achieving ≥15% TBWL. Forty participants (23%) reported side effects. The most frequent were nausea/vomiting (n=27, 15%), constipation (n=6, 3%), and abdominal pain (n=5, 3%). Eight patients (5%) had to either decrease dosage or discontinue the drug due to side effects. Conclusion: In this retrospective cohort study, tirzepatide led to substantial weight loss at 3 months. Patients with T2DM lost less weight than patients without. Further real-world studies with longer follow-up duration and higher tirzepatide doses are needed to establish the long-term efficacy, safety, and tolerability of this drug in this setting. Presentation: Friday, June 16, 2023

What is the Learning Curve for Total Ankle Arthroplasty?

Category: Ankle Arthritis; Ankle Introduction/Purpose: There is limited data concerning the “learning curve” in Total Ankle Replacement (TAR). This study aimed to examine surgeons’ revision rates over time to determine the number of cases after which revision rates plateaued. Methods: Primary TAR procedures for any diagnosis performed by surgeons whose first procedure was recorded by the AOANJRR since January 2008 were analysed. The time to first revision for procedures performed by surgeons with &lt; 15, 15-29, 30-49, and ≥50 prior TAR procedures was summarised using Kaplan-Meier estimates of implant survivorship. Hazard ratios (HR) were obtained from Cox proportional hazards models adjusting for age, gender and the operating surgeon’s number of prior TAR cases, with the latter modelled using restricted cubic splines. Further adjustment for insert mobility was also performed. Results: There were 2,637 TAR procedures performed by 128 eligible surgeons. Procedures performed by surgeons with &lt; 15 prior cases had a cumulative percent revision (CPR) of 15% at 8 years, compared to 11.8% for procedures where the surgeon had previously performed ≥50 TARs. Procedures where the surgeon had 15 prior cases had approximately 1.5 times the hazard of revision of procedures where the surgeon had ≥50 prior cases (HR = 1.57, p = 0.042). The revision rate of procedures in which the surgeon had performed 25 prior cases did not differ significantly compared to those with ≥50 prior cases (HR = 1.24, p = 0.143). Similar results were obtained when adjusting for insert mobility, although estimated revision rates did not differ significantly with number of procedures. Conclusion: The first 15 TAR undertaken by a surgeon have a significantly higher rate of revision compared to those after 50 TAR. This difference reduces after 25 TAR.

Frameless Linear Accelerator (LINAC) Based Radiosurgery (SRS) vs. Framed Gamma Knife SRS for Idiopathic Trigeminal Neuralgia (TN)

Stereotactic radiosurgery (SRS) is an effective treatment for idiopathic trigeminal neuralgia (TN). Conventional treatment is done through frame-based solution due to small target and high radiation dose. More recently, LINAC based frameless SRS technique has been established as a patient friendly alternative. Herein we compared our single institution experience of LINAC based frameless SRS vs frame-based gamma knife SRS for TN. The hypothesis is LINAC based frameless SRS can provide equivalent dosimetric and clinical outcome as compared frame-based gamma knife treatment. Patients with idiopathic TN who received SRS treatment (LINAC based frameless treatment or Gamma knife framed treatment) at our institution from 2015-2022 were included. A minimum follow up of 1 year was required. Patient data was extracted from electronic medical records and radiation treatment planning system. Pain intensity was evaluated utilizing a modified 0-4 Barrow Neurological Institute (BNI) pain intensity score, and then dichotomized where BNI score 0-2 represented response to treatment and BNI score 3-4 represented no response. Statistical analysis was conducted with a linear regression model accounting for race, gender, prior pain, pain distribution including laterality and branch involvement, medication regimen at time of treatment, previous radiation treatment, and prior procedures. Response was then compared between both modalities overall and within each sub-group with chi-square testing and linear regression. A total of 81 patients were identified, 14 patients were excluded due to lack of adequate follow-up, leaving 67 for analysis. 12 (17.9%) were male and, 55 (82.1%) were female. All patients were managed with medication prior to SRS treatment. 5 (7.5%) had rhizotomy and 13 (19.4) had microvascular decompression, and 8 (11.9%) had previous gamma-knife radiosurgery prior to SRS treatment at our institution. Of the 67 patients, 23 (34.3%) received frame-based gamma knife SRS, 44(65.7%) received frameless LINAC treatment. 58 (86.6%) radiation naïve patients received 90 Gy in 1 fraction, while out of the 9 who had previously had intracranial radiation treatment 7 (10.4%) received 70 Gy and 2 (3%) received 80 Gy all prescribed to 100% isodose line. All patients were treated with 4 mm cone. There was no significant difference in brainstem dose between these two techniques. Between LINAC-based or Gamma Knife modalities rate of pain control (77.3 % vs 82.6 %, respectively, p = 0.61) as well as toxicity in facial numbness (31.8% vs 21.7%, respectively, p = 0.38) showed no statistical difference. There was no statistically significant signal (p > 0.05) detected within the subgroups analyzed. The linear regression model also showed no significant difference. LINAC based frameless SRS provides comparable dosimetry and pain control for TN as compared to frame-based gamma knife treatment. It is a patient friendly solution for patients with TN.

Full arthroscopic vs. arthroscopically assisted posterosuperior latissimus dorsi tendon transfer for shoulders with failed and irreparable rotator cuff repair: matched case-control study

To compare clinical outcomes and complication rates of full arthroscopic latissimus dorsi tendon transfer (LDTT) vs. arthroscopically assisted LDTT, for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs) in shoulders that had failed rotator cuff repair (RCR). We evaluated a continuous series of 191 patients who underwent LDTT over 4 consecutive years. A total of 107 patients did not have previous shoulder surgery, leaving 84 patients who had prior surgical procedures. All procedures performed over the first 2 years were arthroscopically assisted (n=48), whereas all procedures performed over the last 2 years were full arthroscopic (n=36). We noted all complications, as well as clinical scores and range of motion at ≥24 months. To enable direct comparison between the 2 techniques, propensity score matching was used to obtain 2 groups with equivalent age, sex, and follow-up. Compared with the 48 patients who underwent arthroscopically assisted LDTT, the 36 patients who underwent full arthroscopic LDTT had comparable complications (13% vs. 11%) and conversions to RSA (8.3% vs. 5.6%). Propensity score matching resulted in 2 groups, each comprising 31 patients, which had similar outcomes in terms of clinical scores (except mobility component of Constant score, which was better following fully arthroscopic LDTT; P=.037) and range of motion at a minimum follow-up of 2years. At a minimum follow-up of 24 months, for the treatment of irreparable posterosuperior mRCTs in shoulders that had surgical antecedents, full arthroscopic LDTT had significantly better mobility component of the Constant score than arthroscopically assisted LDTT, although there were no significant differences in the other clinical or functional outcomes. Arthroscopically assisted LDTT and full arthroscopic LDTT had comparable rates of complications (8.3% vs. 13%) and conversion to RSA (5.6% vs. 8.3%).

Trauma and sporadic desmoid tumor development: An approach toward real incidence and aspects of causality.

The development of desmoid tumors (DT) is associated with trauma, which is an aspect with medicolegal relevance. The objective of this study was to analyze the proportion and type of trauma (surgical, blunt/fracture, implants), its lag time, and mutations of the CTNNB1 gene in patients with sporadic DT. We analyzed a prospectively kept database of 381 females and 171 males, median age at disease onset 37.7years (females) and 39.3 years (males) with a histologically confirmed DT. Patients with germline mutation of the APC gene were excluded. Details of the history particularly of traumatic injuries to the site of DT were provided by 501 patients. In 164 patients (32.7%), a trauma anteceding DT could be verified with a median lag time of 22.9months (SD, 7.7months; range, 9-44months). A prior surgical procedure was relevant in 98 patients, a blunt trauma in 35 patients, a punctuated trauma (injections, trocar) in 18 patients, and site of an implant in 10 patients. In 220 patients, no trauma was reported (43.9%), and 58 females (11.6%) had a postpregnancy DT in the rectus abdominis muscle. In 42 patients (8.4%), data were inconclusive. The distribution of mutations in the CTNNB1 gene (codon 41 vs. 45) was similar in patients with and without a history of trauma before DT development. A significant subgroup of patients suffers from a trauma-associated DT, predominantly at a prior surgical site including implants to breast or groin, accounting for 77.9% of the cases, whereas blunt trauma was responsible in 22.1%. We found no data to support that trauma-associated DT have different molecular features in the CTNNB1 gene.

The revision hip arthroscopy complex: capsular deficiency, labral deficiency, femoral over-resection andadhesions can result ingood survivorship with revision hip arthroscopy.

To evaluate the patient-reported outcomes (PROs) and survivorship of combined arthroscopic hip labral reconstruction/augmentation, capsular reconstruction, femoral neck remplissage and lysis of adhesions. Patients ≥18 years old who underwent this combination of procedures during revision hip arthroscopy and were eligible for minimum 2-year follow-up were identified. PRO scores including Hip Outcome Score (HOS)-Activities of Daily Living scale, HOS-Sports scale, modified Harris Hip Score, Short Form 12, and Western Ontario & McMaster Universities Osteoarthritis Index, patient satisfaction and failure rates were analyzed. Seven patients (5 females and 2 males) with average age of 45.0 ± 5.2 (range: 40-54 years) met inclusion criteria. Patients had a median of 1 (range: 1-3) prior hip surgery at an outside institution. All patients had previously undergone femoral osteoplasty, and 85% (6/7) of patients had a labral repair performed. Four patients had no capsule closure performed in their prior procedures. Six patients were available for minimum 2-year follow-up. Two patients converted to total hip arthroplasty: one patient with four prior hip arthroscopies and the other had advanced osteoarthritis with outerbridge grade 3/4 defects requiring microfracture. Mean patient satisfaction was 7 (range: 2-9). At mean follow-up of 3 years, most patients who underwent the combination of labral reconstruction, capsular reconstruction, femoral neck remplissage and lysis of adhesions during revision hip arthroscopy demonstrated improved PROs. This salvage procedure has the potential to restore hip function in patients who have failed an initial hip arthroscopy procedure. In patients with these pathologies present and concomitant joint space narrowing, a total hip arthroplasty may be a more appropriate salvage option.